Sunday, 8 February 2009

Medical and Geriatric Wards PLEASE READ

I thought I would put this here so anyone who might read this can understand where I work and where I am coming from. I am going to try and keep this as simple as possible.

This blog is a portrayal of working on a 25 bed medical ward in the NHS. Medical wards take people with GI bleeds, Heart problems, Renal problems, Pneumonia, Lung disease, cancer, asthma, sepsis, general deterioration etc etc etc. This means that we are a mainly a geriatric ward. Most people who need to be hospitalized with these problems are elderly. The majority of my patients are completely unable to care for themselves due to extreme illness or dementia. Usually both together. The majority are confused. A severe medical illness will do that to you even if you were totally with it last week.

The opposite of this ward is a general surgical ward. These wards usually have younger patients who have a problem that needs sorting and that is the end of it. Think of the 26 year old male with a hernia. He goes in and has his hernia done. He has no other problems and is self caring. He goes home the same day. Sometimes surgical wards get really sick patients with severe problems but because the nurse's other patients are mainly self caring she can focus on the ill patient without leaving her other patients sat in shit for 4 hours.

The surgical ward is always better staffed than the medical wards. Always. Our hospital has a short stay surgical unit. They take easy cases. Young men like the one I described above are the norm down there. They will never take elderly medical patients as they are usually not suitable for an operation i.e. they'll probably die on the table. They have 15 self caring young patients who have no major medical problems. They get 3 nurses and 1 health care assistant for those 15 patients.

Cardiac wards are staffed in a similiar fashion but are also a lot busier. Even so, a nurse on a cardiac ward will often not have more than 5 patients some of whom are self caring and orientated. Compare this to a medical/elderly ward where the nurse has 15 patients and not one of them can feed themselves. Medical nurse will also have acutely unwell patients who could die if she leaves them long enough to help her more medically stable patients who are incontinant and struggling with basic hygeine.

Orthopedics is usually staffed well compared to medical/elderly and if one of their patients starts going down hill they are immediately sent to a medical ward where the nurse is caught between 20 elderly patients who need to be fed anc cleaned and the patient who came from the ortho ward who is now dying of heart failure because they overloaded him with IV fluids.

This blog is about working on a medical/elderly ward. It is an accurate represention of that without breaching confidentiality.

It is not an accurate representation of your nan's orthopedic ward where she had her hip done, or the surgical ward where you had your tonsils out, nor is it any kind of portrayal of cardiac wards. It is a whole different world from ITU and CCU where the nurse has 1 or 2 patients and massive back up.

My ward is a medical ward. This is the one your grandfather will go to after CCU stabilizes him, or maybe he isn't stable at all when he comes to me and I have to prioritize his care above hygeine care for other patients in order to ensure his survival. My ward is the one where nursing home patients go to when the nursing homes and their families cannot cope and there is no other place for them to go. They are medically stable when they come to me but are confused, malnourished, immobile, aggressive and incontinant and demand one to one care and so do their relatives. The relatives do not give a shit if I have a 30 year old mum down the bottom of the ward who can't breathe and needs a neb and a zillion other interventions to get even remotely comfortable. They don't care that I have a 63 year old who is raising her grandchildren and is now bleeding out due to a GI bleed and needs blood. They will tear me apart for leaving their elderly relative long enough to stablize the others. But the lawyers would tear me apart if I dared to leave an unstable medical patient to take another patient to the toilet. The nurses on my ward are in this position every minute of every shift they work. They are constantly caught between doing basic care for the elderly without harming someone is acutely medically ill. I cannot speak for nurses on surgical, ortho, cardiac, and intensive care wards.

I like caring for elderly people as challenging as it is. I see an old woman and I know that once she was someone's beautiful baby, someone's child who made mummy and daddy so proud. She was a gorgoeus, intelligent and vibrant young woman with plans for her life. She was someone's sweetheart and bride.

My elderly patient with dementia was someone's wife and the glowing mum to a new baby once. She was a shoulder to cry on for her older children and she probably busted her ass to care for her own aging parents as well as her own family. I know that if my own babies live a long time they are sure to end up like the old woman I see in front of me and I hope someone cares for them in their old age.

I know this and my colleagues know this. All of us.

So why does the public think that we hate old people? We don't hate old people. But society and our bosses certainly do.

Read the blog to see what shifts are like for nurses on these wards.


Bibsy said...

Glad you're back with your superb blog!

OK - I'm a relative visiting my 92 yr old dad whose leg ulcers haven't been redressed - the bandages leak & stink. I've read your blog - I know you don't have the time, it isn't your fault. What do I do to help my dad (and you) without landing you in the clart?

Would it help if I saw a manager type person? There always seem plenty available to tell me off if I have a calming ciggie in the Car Park!

Nurse Anne said...

Hi Bibsy.

I feel so bad for your dad. Leg ulcers are horrible and you are right, they don't get cared for properly.

I would complain about it. I don't know whose fault it is as I don't know what his ward is like. We actually encourage people like you to complain. They usually turn it back around on the nurses, but we hope that they get sick of having to handle complaints all the time anyway. I'll give you a good example of what I am saying in my next blog.

nasogastric said...

So glad you are back. I thought 10-12 (and sometimes 22 if a nurse is unwell) acutely mentally unwell patients was shit until I started reading your blog.

Ex-medical Nurse said...

Newly qualified nurse + six months in medical ward and bullying mentor = nervous breakdown at age of 32 and 3 months off sick. Now in cardiothoracic ICU and never looking back. Fuck 'em, you can't change it and you will die trying. Get out. Now.

The Shrink said...

"The majority of my patients are completely unable to care for themselves due to extreme illness or dementia. Usually both together. The majority are confused. A severe medical illness will do that to you even if you were totally with it last week.

I could kiss you. A huge headache I have locally is that some medical teams (and many surgical teams) think confusion = psychiatry = turf.

And, when acutely medically unwell with acute renal failure, the optimal treatment ain't some shrink asking, "So, tell me, how do you feel about that?"

An interesting post, and good to hear there're committed folk who are switched on, and shouting about it :)

Happy1 said...

Makes me soo sad. I started working with the elderly when I was 16..loved them. I only entered nurse training because I wanted to run a nursing home..still do...somehow I'm still a hospital nurse...for now.

The elderly are my favorite patients..they have humour, dignity, pride...they are wise, they make me laugh...they fascinate me with their memories. I absolutely love talking to them and taking time and effort to provide detailed, total care to these patients, laughing along the way, getting to know them. So satisfying.

Have I left an elderly patient sat in shit for hours...YES.

Have I left an elderly patient un-fed, unable to reach food...YES

Have I left an elderly patients dressings way too long...YES

Have I left an elderly patient crying, sobbing, desperate for someone to talk to...YES.

(and I once had to apologise that I was unable to fetch the commode for someone as I was running past..actually had to say NO..had 2 patients in cardiac arrest, only 2 nurses..but the patient wanting the commode didn't know that...probably just thought I was failing my duty...oh..both resus patients survived)

Nursing can be so soul-destroting..there must be so many nurses like me..who have cried at not being able to provide the care that I want to provide(its not just about SHOULD DO...we actually WANT TO!).. the public, the patients, the relatives..the journalists...THEY HAVE ABSOLUTELY NO IDEA.

Soul destroying indeed.

Anonymous said...

I see that nursing is not a lot different between the states and the UK, though I think it's probably heavier there. I cried when I read your beautiful words about who these geriatric patients once were, and how you see them; simply beautiful. You have the heart of the angel I wish so many other "nurses" could have. You're OK in my book, and you have my complete respect. Thanks for the great blog!

Anonymous said...

I work in aged 'care' (nursing homes) and have done for 4 years. Currently, I work in a facility which is 1/3. After 5pm we have a 'on call R.N' who has to drive like a maniac between the 3 facilities.
After 4 years I've concluded 50% of my problems are because of presumptious idiots related to the patient (family), 40% management/staff and 10% my growing frustration.
I don't see the point in continuing with my current employment and have enrolled for training next year in a new career.
It's a fact that no matter how hard I try, or how fast I move, I can't do the job of 10 people. So, I'll just do something else.

viagra online said...

wow I didn't know. how many problem can suffer the person that work in hospitals, I thougth that stress was the major problem, now I gonna take more consciousness to this workers.

Viagra Online said...

What happened to the scrolling blog updates? I liked them. Not complaining, just asking.

xlpharmacy reviews said...

I have to admit that your work is something pretty hard to do it. The problem is when you are loosing your sensibility.

Anonymous said...

Just found you Nurse Anne and I love you <3 You are me!! I'm so fed up of reading articles in the bl**dy Daily Mail. My MFE ward is like a cross between a scene from Resident Evil and the London riots (that's on a good night).................

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